HomeMy WebLinkAboutSeptic Pump 6/15/22 Yarmouth Septage Treatment Facility
Syste Identification
Town Pumped (d ( TelephonC��f#
f 7�/No. (�� ) Street
Village
Owner's Name rwolor
Use: Residence.__( Business Restaurant? Yes No
Reason Pumped: Maintenance ;2Overflow Blockage
Pumper's Observations - Facility Pumped
Septic Tank Cesspool Converted Cesspool
Holding Tank Leach Facility Grease Trap
Porta-Potty Lift Station Other Wastewater Plant
Cover within 1 foot? Yes No Back Flow? Yes No
Gallons Pumped: /00C) Comment:
Hauler Information
/
Company: r r.t.„
Truck No.: ? Date:
:::':;:ature:
Septage Received at Yarmouth
Weighmaster Initials: Date:
Gallons Received: Ticket#: